摘要
目的探讨内关-外关透刺针法对麻醉诱导期血流动力学及术后恶心呕吐(PONV)的影响。方法选择择期在全身麻醉(全麻)下行腹腔镜下三级手术的患者80例,随机分为观察组(40例)和对照组(40例)。观察组剔除3例,对照组剔除1例,实际纳入76例,其中观察组37例,对照组39例。对照组给予常规麻醉诱导,观察组在常规麻醉诱导前行内关-外关透刺针法,右侧留针15 min,左侧留针30 min。两组患者均应用七氟烷复合瑞芬太尼维持麻醉。比较两组患者入室平卧5 min(T_(0))、麻醉诱导前(T_(1))、麻醉诱导后(T_(2))、气管插管前(T_(3))、气管插管后1 min(T_(4))的生命体征,入麻醉恢复室(PACU)(T_(5))、出PACU(T_(6))、术后6 h(T_(7))、术后24 h(T_(8))的视觉模拟评分法(VAS)评分、恶心呕吐发生情况及及恶心视觉模拟评分法(NVAS)评分,相关麻醉药物(枸橼酸舒芬太尼、七氟烷、丙泊酚、酮咯酸氨丁三醇)用量和满意率。结果观察组患者丙泊酚用量(71.8±28.4)mg明显少于对照组的(115.9±25.7)mg,满意率91.9%明显高于对照组的69.2%(P<0.05)。两组患者T_(0)、T_(1)、T_(2)时的收缩压(SBP)、心率(HR)比较差异无统计学意义(P>0.05);观察组T_(3)时SBP(88.5±9.8)mm Hg(1 mm Hg=0.133 kPa)、HR(61.3±10.7)次/min明显高于对照组的(82.0±9.0)mm Hg、(55.9±10.2)次/min,T_(4)时SBP(103.2±8.4)mm Hg、HR(66.9±10.3)次/min明显低于对照组的(124.5±13.8)mm Hg、(74.0±13.1)次/min(P<0.05)。观察组T_(0)时SBP、HR与本组T_(1)时比较差异无统计学意义(P>0.05);T_(2)、T_(3)、T_(4)时SBP、HR较本组T_(1)时明显降低(P<0.05)。对照组T_(0)、T_(4)时SBP、HR与本组T_(1)时比较差异无统计学意义(P>0.05);T_(2)、T_(3)时SBP、HR明显较本组T_(1)时明显降低(P<0.05)。与对照组比较,观察组患者T_(7)、T_(8)时恶心呕吐发生率、NVAS评分及T_(6)、T_(7)时VAS评分明显更低(P<0.05)。结论内关-外关透刺针法可以减轻麻醉诱导期血流动力学的剧烈波动,减少丙泊酚用量,降低术后疼痛程度、恶心呕吐发生率和严重程度,提高患者满意度。
Objective To explore the effect of piercing needling technique from Neiguan to Waiguan on hemodynamics during anesthesia induction and postoperative nausea and vomiting(PONV).Methods A total of 80 patients scheduled for elective laparoscopic gradeⅢsurgery under general anesthesia were randomly divided into an observation group(40 cases)and a control group(40 cases).3 cases were excluded from the observation group and 1 case was excluded from the control group,and 76 cases were actually included,including 37 cases in the observation group and 39 cases in the control group.The control group was given routine anesthesia induction,and the observation group was subjected to piercing needling technique from Neiguan to Waiguan before routine anesthesia induction,with the needle left on the right side for 15 min and the needle left on the left side for 30 min.Sevoflurane combined with remifentanil was applied to maintain anesthesia in both groups.Both groups were compared in terms of vital signs[systolic blood pressure(SBP)and heart rate(HR)]after lying flat for 5 min(T_(0)),before anesthesia induction(T_(1)),after anesthesia induction(T_(2)),before tracheal intubation(T_(3))and 1 min after tracheal intubation(T_(4)),visual analogue scale(VAS)score after entering post-anesthesia care unit(PACU)(T_(5)),exiting from PACU(T_(6)),and 6 h after surgery(T_(7)),nausea and vomiting occurrence,nausea visual analogue scale(NVAS)score,dosage of related narcotic drugs(sufentanil citrate,sevoflurane,propofol,ketorolac tromethamine)and satisfaction rate.Results The observation group had a significantly less propofol dosage of(71.8±28.4)mg than(115.9±25.7)mg in the control group,and and a significantly higher satisfaction rate of 91.9%than 69.2%in the control group(P<0.05).There was no statistically significant difference in the comparison of SBP and HR at T_(0),T_(1)and T_(2)between the two groups(P>0.05).At T_(3),the observation group had SBP of(88.5±9.8)mm Hg(1 mm Hg=0.133 kPa)and HR of(61.3±10.7)beats/min,which were significantly higher than(82.0±9.0)mm Hg and(55.9±10.2)beats/min in the control group;at T_(4),the observation group had SBP of(103.2±8.4)mm Hg and HR of(66.9±10.3)beats/min,which were significantly lower than(124.5±13.8)mm Hg and(74.0±13.1)beats/min in the control group(P<0.05).In the observation group,the differences in SBP and HR at T_(0)were not statistically significant compared with those at T_(1)(P>0.05);SBP and HR at T_(2),T_(3)and T_(4)were significantly lower than those at T_(1)(P<0.05).In the control group,the differences in SBP and HR at T_(0)and T_(4)were not statistically significant compared with those at T_(1)in this group(P>0.05);SBP and HR at T_(2)and T_(3)were significantly lower than those at T_(1)in this group(P<0.05).Compared with the control group,the incidence of nausea and vomiting at T_(7)and T_(8),NVAS score and VAS score at T_(6)and T_(7)were significantly lower in the observation group(P<0.05).Conclusion The piercing needling technique from Neiguan to Waiguan can alleviate the drastic fluctuation of hemodynamics during anesthesia induction,reduce consumptions of propofol,postoperative pain,incidence and the severity of nausea and vomiting,and increase the patient satisfaction.
作者
许际平
丁琳
胡丽华
宋开玲
周存英
XU Ji-ping;DING Lin;HU Li-hua(Rizhao Central Hospital,Rizhao 276800,China)
出处
《中国实用医药》
2025年第11期1-6,共6页
China Practical Medicine
基金
山东省医学会临床科研资金——齐鲁专项研究项目(项目编号:YXH2022ZX02110)。
关键词
麻醉诱导
内关穴
外关穴
透刺针法
血流动力学
术后恶心呕吐
Anesthesia induction
Neiguan point
Waiguan point
Piercing needling technique
Hemodynamics
Postoperative nausea and vomiting
